Albumin Excretion Rate and Cardiovascular Risk

Abstract

Elevated albumin excretion rate (AER) independently predicts total and cardiovascular mortality in a variety of conditions, although the exact mechanisms are unknown. Laser Doppler fluximetry was used to study associations with risk factors and renal damage (AER calculated from a timed overnight urine collection) in 188 people without diabetes and 117 individuals with diabetes. Skin flow (flux) in response to arterial occlusion (ischemia) was measured. Three distinct patterns of postischemic peak flow were observed: 1) gradual rise to peak (normal), 2) nondominant early peak, and 3) dominant early peak. Those with a dominant early peak were more likely to have diabetes (P ‫؍‬ 0.01), hypertension (P ‫؍‬ 0.001), and obesity (P < 0.001) and had a higher AER (12.6 g/min [95% CI 7.8 -20.2] vs. 7.2 [5.5-9.5] nondominant early peak group and 3.7 [3.2-4.1] normal group; P < 0.001 for trend). This could not be accounted for by conventional cardiovascular risk factors (P < 0.001 after adjustment). A rapid peak flow response after ischemia is associated with an elevated AER and increased cardiovascular risk. This may represent shared mechanistic pathways and causative or consequential changes in the microvasculature and supports the hypothesis that microvascular dysfunction may contribute to large vessel pathophysiology.

Microvascular function is impaired in children with morbid obesity

“…[33][34][35][36] Our results are consistent with prior investigations reporting an impaired myogenic vasoconstriction in the microcirculation of diabetic patients undergoing PORH measured by laser Doppler fluxmetry. 21,22 Both a thickened arterial wall structure and endothelial dysfunction have been made responsible for this decline in microvascular functionality. Furthermore, microvascular dysfunction, as described in obese adults, was attributed to various mechanisms.…”

Microvascular function in women with former gestational diabetes: A cohort study

“…Constriction of these precapillary arterioles prevents terminal capillaries from hyperperfusion. 11 As peak perfusion directly reflects microvascular reactivity, peak perfusion was used as primary outcome variable in this study.…”

“…11 PORH as measured by laser Doppler fluxmetry potentially reveals subclinical microangiopathy upon metabolic disorders, such as diabetes. 8,[11][12][13][14] Focusing on GDM, previous research has shown that women with pGDM face an increased risk of macrovascular problems. 15,16 In contrast to GDM-induced macrovascular complications, data on the impact of GDM on microcirculation are inconsistent.…”

“…9,10 Microvascular blood flow is adjusted by the tone of precapillary arterioles, which prevent the terminal network from hyperperfusion. 10,11 Consequently, microvascular blood flow during PORH mainly depends on the regulatory function of precapillary arterioles. 11 PORH as measured by laser Doppler fluxmetry potentially reveals subclinical microangiopathy upon metabolic disorders, such as diabetes.…”

“…10,11 Consequently, microvascular blood flow during PORH mainly depends on the regulatory function of precapillary arterioles. 11 PORH as measured by laser Doppler fluxmetry potentially reveals subclinical microangiopathy upon metabolic disorders, such as diabetes. 8,[11][12][13][14] Focusing on GDM, previous research has shown that women with pGDM face an increased risk of macrovascular problems.…”